Healthcare Provider Details

I. General information

NPI: 1437170222
Provider Name (Legal Business Name): JEANETTE E SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/30/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD FALLS RD
FALLSBURG NY
12733-5505
US

IV. Provider business mailing address

PO BOX 629
WURTSBORO NY
12790-0629
US

V. Phone/Fax

Practice location:
  • Phone: 458-434-6800
  • Fax:
Mailing address:
  • Phone: 845-888-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number075613-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: